[Hemorrhagic disease of newborn in children's hospital at damascus university and medical staff compliance to prophylactic vitamin k administration]

To determine the morbidity and mortality due to hemorrhagic disease of the newborn HDNB [vitamin K induced hemorrhagic disease] at Damascus University Children's Hospital [DUCH], and degree of medical staff compliance for applying related guidelines. A retrospective descriptive study of 307 patients with the diagnosis of HDNB at DUCH during 2000-2009. Ages ranged between 1 day and three months. Clinical, hematological and imaging studies were considered in all cases before final diagnosis of HDNB were established. A specimen of 307 patients were diagnosed having HDNB after the national guidelines for prophylactic vitamin K administration to newborns were established in 2000 by ministry of health. Early HDNB was found in 5.8%, classic HDNB in 14.3% and late HDNB in 78.8%. Home delivery contributed 32.9% of cases where hospital delivery 52.44% and private clinic delivery in 14.6%. Vitamin K injection after delivery was given in 14.2% [28 of 197] of well documented cases. Intra cranial hemorrhage was the most common complication especially in the late form of the disease 54.1%. Other hemorrhagic complications were as follows: skin 14.9%, gastrointestinal 18.6% and circumcision 8.7%. Death occurred in 23% of cases [n=71]; seizures occurred in 10% of survivors HDNB is still present as a cause of morbidity and mortality in newborn period and early infancy in area of the study; vitamin K administration at delivery is not a routine practice despite of clear national guidelines

Late hemorrhagic disease of newborn.

The clinical features of 14 infants diagnosed with late hemorrhagic disease of newborn (LHDN), of which 10 did not receive vitamin K prophylaxis, are presented. All infants were exclusively breast-fed and 12 did not have any underlying illness to explain the abnormal coagulation profile. The common presenting symptoms were seizures (71%), vomiting (57%), poor feeding (50%) and altered sensorium (36%). Physical examination shared pallor in all infants and a bulging anterior fontanel in 64%. Intracranial bleed was the predominant manifestation (93%), with CT scan showing intracranial bleed in 78%. Eight infants (57%) succumbed to their illness, while 36%had neurological sequelae. Since LHDN leads to significant morbidity and mortality, it should be prevented by providing vitamin K prophylaxis to all newborns.

Uso da vitamina K no periodo neonatal: parenteral x oral / Vitamina K in the newborn infant: parenteral x oral use

A vitamina K e amplamente utlizada logo apos o nascimento, para a prevençäo da doença hemorragica do recém-nascido. Esta patologia se apresenta sob varias formas: precoce, "clássica" e tardia, sendo esta última a de maior morbidade, por provocar hemorragias intracranianas. A vitamina K pode ser administrada por via parenteral ou oral, cada qual com suas vantagens e desvantagens. Ao se optar pela forma oral e necessario adotar um esquema de multiplas doses, para que a profilaxia da forma tardia seja eficaz

Enfermedad hemorrágica del recién nacido, Vitamina K y cáncer

Pensamos que la enfermedad hemorragica del recien nacido se prevenia de una forma simple y sin ninguna complicación, sin embargo el estudio de Golding en 1992, planteó serias dudas en cuanto a la asociación entre la aplicació IM de vitamina K y diversas formas de cáncer en la infancia. Paises como el reino unido, Alemania, y Australioa suspendieron su aplicación , administrandola por via oral, pero desafortunadamente se han incrementado los casos de la enfermedad. Aparecieron posteriormente dos estudios que no encontraron relación entre cáncer y vitamina K, y se plantea ahora una intensa discusión , la cual se revisa brevemente junto con las formas de presentación de la enfermedad y las mediciones de la vitamina K1 en la leche humana y las leches de formula. en conclusion se requieren más investigaciones para aclarar si existe o no relación entre vitamina K y cáncer, y por el momento debe continuarse su administración por vía intramuscular, y se reafirma la importancia de la lactancia materna, apesar de que la cantidad de vitamina K disponible en ella es menor que la de las leches de fórmula

Hemorragia periventricular neonatal / Neonatal periventricular hemorrhage

De las hemorragias, la periventricular neonatal es una de las que ocurren con mayor frecuencia en prematuros con menos de 32 semanas de gestación. Asimismo, en este estudio se consideran otros factores de riesgo que incrementan la irrigación sanguínea cerebral y que provocan sangrado en la región subepindimaria de la matriz germinativa. Se distinguen dos síndromes clínicos fundamentales: el catastrófico y el saltatorio, determinados por la magnitud de la hemorragia. El diagnóstico definitivo se lleva a cabo mediante tomografía computada o ultrasonografía, aunque el tratamiento preventivo debe ser el de primera elección. En cuanto a la hidrocefalia posthemorrágica, la derivación ventriculo-peritoneal es el tratamiento final